Acil cerrahi girişim uygulanan geriatrik hastalarda preoperatif kırılganlık ve malnütrisyonun postoperatif takip, tedavi ve hastane yatış süresine etkisi
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Date
2021
Authors
Kaya, Ercan
Journal Title
Journal ISSN
Volume Title
Publisher
Bursa Uludağ Üniversitesi
Abstract
Geriatrik hastalar arasındaki fiziksel farklılıklar hastane yatış süreçlerinde de farklılıklara yol açar. Çalışmamızda; 65 yaş ve üzeri, acil cerrahi girişim uygulanan hastalarda, preoperatif kırılganlık ve malnütrisyonun; postoperatif takip, tedavi ve hastane yatış sürecine etkisini saptamayı amaçladık. Çalışma, etik kurul onayı ve hastalardan alınan yazılı onam sonrası acil cerrahi girişim uygulanacak 65 yaş ve üzeri 150 hastada gerçekleştirildi. Hastalara preoperatif dönemde FRAİL Kırılganlık Ölçeği ve Mini Nutrisyonel Değerlendirme Testi- Kısa Formu (MNA-SF) uygulandı. Postoperatif 30 günlük sürede hastane yatış süreçleri incelendi. Bu süreçte hastaların toplam yatış süreleri, tekrar opere edilme sayıları, tekrar hastaneye başvuruları, postoperatif yoğun bakım (YB) takibi gerekliliği, postoperatif komplikasyon gelişimi ve mortaliteleri incelendi. Çalışmamızda kırılganlık ve malnütrisyon düzeyleri artan hastalarda uzamış hastane yatış süresi (p<0,001, p<0,001), postoperatif YB takibi gereksinimi (p<0,001 p=0,001), tekrar opere edilme sıklığı (p=0,001, p=0,003), postoperatif komplikasyonlarda (p<0,001, p<0,001) ve mortalitede artış (p<0,001, p<0,001) istatistiksel olarak anlamlı olarak fazla idi. Yeniden hastane başvuru kırılganlık düzeyiyle anlamlı artış gösterirken (p=0,002), malnütrisyon düzeyi yeniden başvuruyu etkilememişti (p=0,141). Sonuç olarak; preoperatif kırılganlık ve malnütrisyon durumlarının, acil cerrahi girişim uygulanan geriatrik hastaların hastane yatış sürecine olumsuz etkileri olabileceğini saptadık. Preoperatif dönemde kırılganlık ve malnütrisyonunun rutin olarak belirlenmesiyle alınacak önlemlerin, opere edilecek geriatrik hastaların tedavi sürecinde faydalı olabileceğini düşünmekteyiz.
Physical differences between geriatric patients also lead to differences in the hospitalization process of the patients. In our study, the preoperative frailty and malnutrition status of the patients aged 65 and over who underwent emergency surgery, in the postoperative 1 month period; We aimed to see the effect of hospital stay and follow-up treatment process. The study was carried out with 150 patients aged 65 and over who would undergo emergency surgical intervention after approval ethics committee and written informed consent form from the patients. FRAIL Frailty Scale and Mini Nutritional Assessment Test-Short Form (MNA-SF) were applied to the patients in the preoperative period. Hospitalization processes were examined during the postoperative 30-day period. In this process, the total length of stay of the patients, the number of re-operations, re-admissions to the hospital, the necessity of postoperative intensive care unit (ICU) follow-up, the development of postoperative complications and mortality were examined. In our study, increased frailty and malnutrition levels, prolonged hospital stay (p<0.001, p<0.001), increased need for postoperative ICU follow-up (p<0.001 p=0.001), increased frequency of reoperation (p=0.001, p=0.003), increased postoperative complications (p<0.001, p<0.001) and increased mortality (p<0.001, p<0.001) were found to be statistically significant. While re-admission to hospital increased significantly with frailty level (p=0.002), no statistically significant correlation was found with increase in malnutrition level (p=0.141). As a result; we determined that preoperative fragility and malnutrition might have adverse effects on the hospitalization process of geriatric patients iv who underwent emergency surgery. We think that routine determination of preoperative frailty and malnutrition may be beneficial in the treatment process of geriatric operative patients.
Physical differences between geriatric patients also lead to differences in the hospitalization process of the patients. In our study, the preoperative frailty and malnutrition status of the patients aged 65 and over who underwent emergency surgery, in the postoperative 1 month period; We aimed to see the effect of hospital stay and follow-up treatment process. The study was carried out with 150 patients aged 65 and over who would undergo emergency surgical intervention after approval ethics committee and written informed consent form from the patients. FRAIL Frailty Scale and Mini Nutritional Assessment Test-Short Form (MNA-SF) were applied to the patients in the preoperative period. Hospitalization processes were examined during the postoperative 30-day period. In this process, the total length of stay of the patients, the number of re-operations, re-admissions to the hospital, the necessity of postoperative intensive care unit (ICU) follow-up, the development of postoperative complications and mortality were examined. In our study, increased frailty and malnutrition levels, prolonged hospital stay (p<0.001, p<0.001), increased need for postoperative ICU follow-up (p<0.001 p=0.001), increased frequency of reoperation (p=0.001, p=0.003), increased postoperative complications (p<0.001, p<0.001) and increased mortality (p<0.001, p<0.001) were found to be statistically significant. While re-admission to hospital increased significantly with frailty level (p=0.002), no statistically significant correlation was found with increase in malnutrition level (p=0.141). As a result; we determined that preoperative fragility and malnutrition might have adverse effects on the hospitalization process of geriatric patients iv who underwent emergency surgery. We think that routine determination of preoperative frailty and malnutrition may be beneficial in the treatment process of geriatric operative patients.
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Keywords
Kırılganlık, Malnütrisyon, Hastane yatış süreci, Frailty, Malnutrition, Hospitalization process
Citation
Kaya, E. (2021). Acil cerrahi girişim uygulanan geriatrik hastalarda preoperatif kırılganlık ve malnütrisyonun postoperatif takip, tedavi ve hastane yatış süresine etkisi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.